Paidamoyo Chipunza and Sheillah Mapani Features Writers
The year 2018 began with Government implementing remedial health policy as part of the 100-day economic stimulus plan to make health services accessible to all. Included in the plan is the scrapping of medical fees for infants, senior citizens, pregnant and nursing mothers and slashing the price of blood to $50 at State-run institutions.
The reprieve has been made possible by a more generous budgetary allocation from Treasury, which has brought relief to many in these times of economic hardships. Many have applauded and welcomed this move saying it will make health services accessible to vulnerable populations in line with global commitments on universal health coverage.
This remedial policy, though plausible, has been there since 1980 but had not been fully implemented due to shortages of funding. Executive director of Community Working Group on Health, Mr Itai Rusike, indicated that the recent user fee removal was an advancement of a policy formulated in 1980. The policy was encumbered by a number of weaknesses which Government must address with speed.
“In 1980 a policy of free health care for those on low incomes (below $150, $220)was introduced, and user fees were reduced as a financing source,” he said. “It seems the plan will now be put into action. The policy position on user fees has always been that those who can afford to pay for services should do so but those who cannot should be exempted,” he said.
“He noted that the policy was crippled by the prevailing unemployment rates. The swelling numbers have made the discretionary process of separating deserving persons difficult. Managing exemption from fees has been difficult and costly, with some consequent injustices in who was exempted,” said Rusike.
“In 1990, more emphasis was placed on fee collection although after evidence of high dropout from services, user fees in rural primary health care services were suspended in 1995. The Medical Service Act (1998) gave the Minister the authority to fix fee at Government and State aided hospitals,” said Mr Rusike. He said despite it being a helpful measure from the government, the policy of user fees was viewed as a hindrance to the nation because those who could afford better health standards ended up settling for the free services.
“The National Health Strategy for Zimbabwe 1997-2007 was aimed at free treatment for the majority but also stated that the policy of free health creates a disincentive for people to join medical insurance schemes.”
He added; “Poor people thus faced a variety of de facto barriers: the falling real value of threshold for free care, transport costs, private purchase of medicines due to drug stock-outs and poorly functioning exemption schemes. At the same time higher income earners obtained a number of tax funded public subsidies, including tax relief for medical insurance subscriptions and free services due to difficulties with determining earnings and a treat-first, pay later practice, he enlightened. Even though the policy adjusted in most urban centres, it has never changed in the rural areas.”
“Pregnant mothers, children under five, and adults over 65 years are exempt from fees up to district level but this has been mainly funded by development partners through the RBF funded by the World Bank and the Health Development Fund (HDF), a basket funded by multiple donors that pooled resources in an effort to achieve the complete removal of user fees for the above vulnerable groups.”
He said lack of funding hindered policy implementation, which if not sufficiently addressed can still affect today’s 100-day economic plan. The question has been how the implementation will differ with the old times? There have been concerns about how the government is going to fund the health institutions since the majority of the people are to get the free service? Are health standards going to remain the same under the reduced payments?
Government has assured the nation that there will be no hitches in services, instead sights are on improvements. Minister of Health and Child Care Dr David Parirenyatwa said resources were being mobilised to smoothen the implementation of the idea.
“We want to make sure that all health services are not only available, but also accessible to everyone. We have availed a subsidy of $4,2 million to the NBSZ (National Blood Service Zimbabwe) for them to meet some of the costs associated with blood collection and processing.” There is a budgetary allocation useful for this goal.
“Government is collecting at least $4 million every month from the cellphone levy, the majority of which is used to procure medicines. A five percent allowance is deducted from every $1 worth of airtime bought and is then channelled towards the Health Levy,” said Dr Parirenyatwa.
“Despite the anxiety around the new implementation matrix, hospitals have positively complied with the implementation for many patients have confirmed to the reality of this episode.
“We really appreciate the government’s efforts in making the health services accessible because many were failing to meet the hospital bills leading to a number of people dying,” said Charity Kanhanda, a patient at Parirenyatwa hospital.
“As women we acknowledge the love and appreciation the government has given us as mothers of the country since we are getting everything at maternity for free.” Many also applauded the government’s reduction of blood prices.
“We now have a good government with people at heart. We are so thankful that the government is fulfilling all its promises because I actually bought blood at $50, which is a better price than before,” said Brian Chimboza of Warren Park.
Stimulated by the nation’s response to the implementation, the Permanent Secretary for Health and Child Care, Dr Gerald Gwinji, commended the government’s effort considering the challenges it has been facing towards the implementation. He added; “The main challenge for implementation has been availing commodities and equipment in the face of low budgetary support. Some mechanism must pay for this service when it is eventually availed as free service to the categories of clients.”
“Fears on the implementation of the idea may not be around for long. We have over the years strategised and built support around care for children under five and pregnant women both from government and partners,” said Dr Gwinji. Key challenges which have been plaguing the idea are in the process of being ironed out.
“The main issues were around commodities and this has been largely addressed through various funding mechanisms. The Health Levy, dedicated to commodities like medicines and medical sundries has come in to further strengthening this position,” he said. Dr Gwinji comented on the government’s health budgets that had distressed some citizens considering the economic challenges the nation is facing.
“We have also had slightly better budgets this time around. Putting all this together we feel we have gone over the threshold where we really can support other clients with Assisted Medical Treatment Orders support.
“Going forward, the health financing policy, if fully supported, will create further opportunities for sustainable health care financing from diverse sources of revenue,” assured Dr Gwinji. Health care was one of the most discussed issues within the previous administration.
Concerns with access were raised on numerous occasions. This intervention is likely to bring reprieve to citizens who have been struggling to access health services because of financial constraints.
In extreme cases, hospitals detained new mothers until they had settled their maternity bills. Situations of that nature may be on their way out if the new policy is fully implemented for the benefit of pregnant women, children under five and senior citizens.
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